Will You Get Osteoporosis If You Take Omeprazole?

Do you take omeprazole (Prilosec) or another proton pump inhibitor such as esomeprazole (Nexium) or lansoprazole (Prevacid)? Such PPI drugs were once thought to be relatively free of side effects, but scientists have discovered a number of disturbing long-term problems caused by these medications. These medicines can be useful for healing ulcers or overcoming severe acid reflux, but they can also alter the gut microbiome and cause liver damage. We also worry about kidney problems, heart attacks, strokes and dementia. Readers have also been alarmed to learn that they are linked to a higher risk for osteoporosis.

PPIs and Weaker Bones

When a healthcare provider prescribes you a medicine, they are usually focused on just the one condition for which you sought help. They might not think about long-term consequences for other body systems.

A gastroenterologist who prescribes heartburn medicine, for example, may not warn you about its potential effect on bone density. You might have to deal with the eventual impact on bone strength, however.

A reader sent us the following story:

“My DEXA [a measure of bone density] was normal before my doctor prescribed a PPI [proton pump inhibitor] for acid reflux. After nearly a decade on these meds, another DEXA showed osteoporosis in both my spine and hips.

“Thanks to the People’s Pharmacy warnings about the risks of osteoporosis from PPIs, I had stopped taking it just before the new test. Consequently, I was not surprised at the results of my scan. I attribute it to the PPIs that were prescribed like candy back in the day.

“My entire adult life I had done daily weight-bearing aerobic exercise. I added weight-lifting and balance work in my 40s, got sufficient calcium through my diet and took supplemental vitamin D.

No More Heartburn, But Lingering Bone Loss

“After quitting the PPI, my reflux improved with healthy lifestyle changes. Recent endoscopies are normal. Unfortunately, the damage to my bones was already done.

“Because of this negative experience, I am leery of prescription drugs that physicians keep urging me to take for osteoporosis. I have researched them all. In my opinion, the available osteoporosis drug options can have some scary side effects that are not worth it for me. The Number Needed to Treat (NNT) for one person to have the benefit of not fracturing is not good enough for me to take the chance of serious side effects.

“I looked up the NNT on these drugs. If it was one, the risk benefit decision would be easy. But most, if not all, of these drugs have numbers in the double digits or even higher. Let’s say as a hypothetical that the NNT is 30. That means one person does not develop a fracture while the other 29 fracture. Even worse, they might have unwanted side effects. Those 29 patients would risk complications without protection against fracture. Those odds are not worth it for me.

“Ask your doctor the NNT for any drug you are prescribed for osteoporosis. You might be shocked at how only a few people treated actually benefit. Not enough doctors emphasize this fact.”

We appreciate this reader’s dilemma. Taking prescribed medication for years may well have resulted in osteoporosis. She clearly was not warned of this possibility in advance.

Steroids Could Also Weaken Bones

Another common medication that affects bones is a steroid such as prednisone or prednisolone prescribed for asthma, COPD or serious immune system reactions. Testosterone blockers for prostate cancer, aromatase inhibitors for breast cancer and even SSRI antidepressants can also weaken bones over time (American Journal of the Medical Sciences, Jan. 2025).
There are many other examples of delayed adverse drug reactions. People should always find out how helpful a medicine will be for their problem (the NNT). Just as important, they should learn about serious, long-term complications.

Do People Who Take Omeprazole Have More Fractures?

Q. Not one physician of any kind ever told me that taking omeprazole can cause osteoporosis.

I’ve been taking the drug for many years and just was diagnosed with the disease. I will wean myself off of omeprazole if I can. Do you have recommendations?

A. A large study found that stroke patients taking proton pump inhibitors (PPIs) like omeprazole were more likely to develop osteoporosis and hip or spinal fractures (Osteoporosis International, Jan. 2018). A meta-analysis of 33 studies including 2.7 million participants found a greater risk of fractures the longer people took PPIs (Journal of Bone Metabolism, online, Aug. 31, 2018). Another meta-analysis found that people who take PPI medicines are 26 percent more likely to break a hip than those who do not (Rheumatology International, Aug. 29, 2018).

Could People who Take Omeprazole Switch to a Different Medicine?

Other drugs such as ranitidine (Zantac) or famotidine (Pepcid) may also ease discomfort. These drugs, called H2 blockers, don’t necessarily carry the same risks as PPIs.

Q. I have been taking omeprazole for several years. With all the recent information about the nasty side effects of PPIs, I have decided to wean myself off it.

Ranitidine is giving me good results, but I am wondering if this product is also a PPI. When I tried to look it up on the Internet, I could not find the answer to this question. Is ranitidine any safer than a doctor-prescribed PPI?

A. Ranitidine (Zantac) is not a proton pump inhibitor (PPI). Like cimetidine (Tagamet) and famotidine (Pepcid), it blocks stomach acid production through a different mechanism.

Because these H2 antagonists are less potent, they are generally less likely to cause complications like chronic kidney disease (JAMA Internal Medicine, Feb., 2016). On the other hand, both types of heartburn drugs can interfere with the absorption of B vitamins (especially vitamin B12) from food (Annals of Pharmacotherapy, May 2002).

Learn More:

Our Guide to Digestive Disorders has advice about other ways to deal with heartburn and strategies to discontinue PPIs. Some people find deglycyrrhizinated licorice (DGL) or ginger helpful in controlling rebound hyperacidity.